This is in reference with an article on the CDC"S site and avert.org: "Primary HIV Infection Associated with Oral Transmission" A programme in San Francisco studied 198 people, nearly all gay or bisexual men. The subjects stated that they had only had oral sex for a year, from six months preceding the six-month study to its end. 20 per cent of the study participants, 39 people, reported performing oral sex on partners they knew to be HIV positive. 35 of those did not use a condom and 16 reported swallowing cum. No-one became HIV positive during the study.

In June 2002, a study conducted amongst 135 HIV-negative Spanish heterosexuals, who were in a sexual relationship with a person who was HIV-positive, reported that over 19,000 instances of unprotected oral sex had not lead to any cases of HIV transmission.

At the 4th International Oral AIDS Conference held in South Africa, the risk of transmission through oral sex was estimated to be approximately 0.04 per cent per contact.

My questions:-

Q1>Many experts say that hiv can be transmitted even through a healthy mouth.I dont understand that if this "theorotical"saying is true even in "REAL" life....why are we getting contradictory results when tests are performed...in which as u can see ...even after 19000 instances there is no single case found ?

2> Ok lets keep the above study aside.Apart from this study,uptil now,has any one found a documented case in which it is proved that hiv transmission has taken place even when the "performer" had a healthy mouth?...If "yes" plz tell me about it.

Note:- (I know there are a few documented cases found but in most of those cases the performer had dental problems).

3> If experts feel that their "theorotical possibility"is not just in theory and can also take place in real life then how is that after two decades of epidemic and amongst millions of cases they cant find one single case to prove that oral sex transmission has taken place through a healhty mouth ?

4> Finally,I am frustated what should I belive.My wife is hiv positive and am negative.she loves oral sex but we both are worried if its safe for me.I dunno whether I should believe on the Study results which suggest that its probably safe unless u have a wound/cut/sore,or do i believe to the "theorotical" possibility of Micro cuts transmission which I feel is "non-existant" in " real life"...? PLZ COMMENT as am unable to decide.

Sir, am aware that my questions are very long and complicated.PLZ TAKE all the time you want BUT *PLZ REPLY BACK*.PLZ DONT IGNORE my email.

Anxiously Awaiting your Response,

Response from Dr. Remien

It seems to me that you are looking for a very definitive answer on the precise level of risk of HIV transmission from oral sex. You and many, many people out there would like to have this. However, I don't think that anyone can give that to you, at this time. And yes, it is frustrating to have experts talk about "theoretical" risk.

You appear to be quite knowledgeable on the matter and also know how to find articles published on the topic. I also believe that your "take" on the issue is pretty accurate. In fact, it is because there is such a lack of evidence that clearly points to transmission of HIV through oral sex, that it is labeled as "minimal" or "very low" in most prevention messages.

The reason that experts will talk about a theoretical risk is because it is biologically possible for HIV to be transmitted through the oral cavity because it is a mucous membrane that has access to the circulatory system. And the fact that there are cases in the literature that point to oral sex being the presumed mode of transmission. But again, as you rightly point out, it is hard to find any reports that document there being substantial risk. When you ask the question about a"healthy mouth," it gets even more complicated. How does one define a "healthy mouth" and how would that be determined? by whom? and when?

You are struggling with an issue that many other mixed status couples struggle with, regardless of gender and sexual orientation. The issue for couples is how do they freely and comfortably engage in activities that are pleasurable, but may carry some level of risk for HIV transmission, even if that risk is extremely small? Each couple must figure this out for themselves. They must balance the benefits and potential costs. With the level of risk being so small for transmission of HIV via oral sex, are you both willing to take that very small risk for the benefits of the pleasure and intimacy that it provides. I know of a lot of couples in your shoes who would say yes, that is a risk we are willing to take. Some couples decide to engage in this activity with the use of protection (e.g., dental dams, saran wrap), while others think it is not worth it when using such things. But again, I don't think anybody can tell you what to do nor give you the guarantee that you seem to be looking for.

I suspect you will continue to be frustrated by this response, but I believe it is the best I can offer you, given my range of expertise. And you should know, that I am a psychologist with a lot of experience in counseling couples. However, I am not a medical expert, nor an epidemiologist.

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